Pre-Pregnancy Checklist Helps Prepare Couples

by Craig L. Bissinger, MD, FACOG

preconception checkupSo you have decided to have a child. Congratulations! Welcome to a whole new world of choices.

Never before have your decisions had such a profound impact on another person. Everything you eat, drink and smoke will affect your baby.

But before you throw away your morning coffee or tea take a few minutes and read these common sense thoughts on pregnancy.

The Realities of Pregnancy

The first thing I do with my patients is remind them of the reality of pregnancy. Women have been having babies since pre-historic times. Somehow, the species survived without all the current hoopla surrounding pregnancy and childbirth.

I often ponder the reason we affix so many rules to this exciting time of our lives and I think I have an answer. We are used to being in control of our lives and bodies. We walk, run, jump and skip when we choose.

During pregnancy, there is an alien being within our midst, taking control of many of our bodily functions. To compensate for this lack of power, we look for ways to fight back. Watching what we eat is a great example of control. Avoiding caffeine, cigarettes and NutraSweet are just a few of the controls we impose.

Getting Pregnant: Cycles and Baby Making

Getting pregnant can be the easiest or most frustrating event in your life. All these years you've tried to avoid pregnancy and now you are ready.

The first thing to remember is that most couples will get pregnant (85 percent get pregnant within 12 months of unprotected intercourse). For the 15 percent who don't, there are a variety of tests to help decipher the cause and help them conceive.

Second, it is helpful to understand the menstrual cycle and when a woman is most fertile.

Every woman has her own unique cycle. A cycle refers to the number of days between the beginning of two consecutive menstrual periods. We will use a standard twenty-eight day cycle as our example but the rules will apply to cycles of 21-40 (or more) days as well.

The release of an egg (known as ovulation) occurs around fourteen days before the beginning of the next menstrual period. Ovulation is the period of maximum fertility. In the case of a twenty-eight day cycle, ovulation would occur 14 days after the first day of a menstrual period, regardless of the number of days of menstrual flow. To give another example, if a woman's cycle was 40 days, she would ovulate roughly 26 days after the first day of her period (because 40-14=26).

At ovulation, there are other signs that may be present. The cervical mucous becomes very thin and clear, resembling a raw egg white. Another sign is the onset of a sharp or dull aching in the right or left lower part of your abdomen, which can last from 12-36 hours. This is known as mittelschmerz and occurs when an egg is being released from the ovary. Another way to determine the time of ovulation is to do a home ovulation predictor test. This simple urine test, available at many drug stores, can predict ovulation 24-36 hours in advance.

In any case, it takes two to tango. Intercourse should occur on a regular basis around the time of ovulation. I have always suggested trying to have relations every 24-48 hours, starting two days before you expect ovulation. In order to account for the occasional irregular month, I recommend continuing this regimen for a few days past your expected ovulation.

Now, let's talk about how to have a Valentine's baby. We can't control the nature of our menstrual cycle but we can at least figure out when a baby will be due based on it.

This involves using a simple math equation. To time the estimated due date, take the first day of the last menstrual period, subtract 3 months then add 7 days to get the estimated due date (which may be the following year). In the case of Valentine's Day, the last period should begin on May 7th (because May 7th - 3 months + 7 days = a due date of February 14th of the following year).

A Good Lifestyle for Pregnancy

Being physically fit is important no matter what you do. It can be a terrific aid for pregnancy as well. I recommend being on an aerobic exercise program before getting pregnant.

If you were to choose a program with pregnancy in mind, I'd prefer a low-impact program such as swimming, walking or biking. All these activities are easy on the joints and the baby. I have found that my intense runners and weight trainers tend to ease off considerably during pregnancy due to the changes they experience.

This isn't to say that they couldn't continue their routine but they tend to modify it considerably. In addition, vigorous exercise tends elevate the pregnant woman's heart rate above the American College of Obstetricians/Gynecologist's recommended maximum heart rate of 140 beats/minute.

In anticipation of pregnancy, it is a good thing to get in the habit of eating three healthy meals per day. For those of you who are underweight, expect your doctor to encourage you to eat a little more when you are pregnant.

If you are considerably overweight, don't be surprised if your physician encourages you to lose weight in advance of pregnancy. However, there is no specific weight at which pregnancy is unsafe provided that your weight hasn't caused you to have other health-related problems.

In addition to eating well, pre-pregnancy ingestion of folic acid has been shown to reduce the risk of certain nervous systems diseases such as spina bifida. The addition of 0.4 mg of folic acid at least a month prior to attempting conception is recommended.

If you have had a prior child affected with spina bifida or other related diseases, you may be advised to take up to 4 mg of folic acid daily. Folic acid can be found in enriched bread and leafy vegetables, or taken as a supplement.

Ingesting 1200 mg of calcium and taking a multivitamin each day are the other pre-pregnancy suggestions to ensure an adequate supply of nutrients for a developing fetus. Some women take a multitude of supplements prior to getting pregnant.

Although they may have certain beneficial effects in the non-pregnant state, nobody can say for certain whether supplements are or are not safe during pregnancy. It has been discovered that Vitamin A in doses above the RDA (recommended daily allowance) can be hazardous to the fetus, with the potential to cause birth defects.

I often suggest to patients to discontinue all their vitamin supplements and take a daily prenatal vitamin in anticipation of getting pregnant. This way, a woman doesn't have to worry about whether she is getting the proper amount of each vitamin and mineral.

Vaccinations and Genetic Testing

Have you been re-vaccinated for the measles? For many women born after 1956 and before 1980, the answer is no. The vaccine you received as part of your childhood immunizations is wearing off! I advise my patients to get the vaccine in advance of getting pregnant. The only downside is that you must wait three months to get pregnant after getting the shot because it contains a weakened strain of measles which could cause problems for a baby.

In addition, I check with patients about chicken pox and tetanus. If you haven't had chicken pox, you may be a candidate for this vaccine. If you receive the vaccine, you should wait one to three months prior to conceiving. The tetanus shot should be administered every ten years. It can be given without any waiting period. It can also be given if necessary during pregnancy (e.g. if your skin gets cut with a rusty metal object).

"We are who we were" is a pretty good adage when it comes to being parents. Learning about your family health and genetic background can be important in preparing for a pregnancy. We can harbor genes for diseases such as cystic fibrosis or sickle cell anemia without knowing it. Fortunately, many diseases have pre-pregnancy testing available so we can discover who might be carriers of these maladies. If there is a genetic disorder in the family, I suggest the couple speak with a geneticist before getting pregnant.

Smoking and Other Drug Use

The label on a pack of cigarettes offers a succinct warning about the risks to the unborn child from exposure to smoke. We know smoking has been associated with a diminished capacity to get pregnant. In addition, smoking during pregnancy is associated with premature birth and smaller babies. Children of smokers tend to have more lung conditions (including asthma) than those of non-smokers.

I plead with my smokers to quit "cold turkey" before pregnancy. If they haven't stopped, I strongly encourage that they stop or smoke as little as possible. The use of nicotine gum, patches and medication is not recommended during pregnancy.

Illicit drugs should never be used during pregnancy. They can have major impacts upon an unborn child. Alcohol can also be very harmful during pregnancy. In advance of conceiving, mild (1-2 drinks per day) alcohol consumption is permissible. Those who abuse alcohol may have a harder time getting pregnant because of its effect on their general health.

Pregnancy can be the most exciting (and scary!) time of a woman's life. Millions of women have gone through successful pregnancies in the past and much of what we know is based on their experiences. A few simple preventative measures can help to ensure that your pregnancy goes as smoothly as possible and that your child is born as healthy and happy as can be.

Craig L. Bissinger, MD is a board certified Obstetrician/Gynecologist practicing in Parsippany, NJ. Dr. Bissinger is vice-chairman of the Department of OB/GYN at Morristown Memorial Hospital where is is also actively involved in teaching medical students and residents.

Copoyright © Craig Bissinger. Permission to republish granted to Pregnancy.org.